#723 Bold Beginnings: Long Acting Insulin

OmnipodJuicebox PodcastInterviewType 1 DiabetesBold Beginnings

Jul 22

Bold Beginnings will answer the questions that most people have after a type 1 diabetes diagnosis.

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DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.

Scott Benner 0:00
Hello friends, and welcome to episode 723 of the Juicebox Podcast.

When Jenny and I pressed record on this bulb beginnings episode, we thought this isn't going to take long at all. And it didn't take long, but it didn't. It didn't go as quickly as we thought. What I'm saying is, there was more to get into than we initially considered. And that's why I like these conversational episodes. Today's is about long acting insulin. While you're listening, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan. We're becoming bold with insulin. If you're enjoying Jenny, and you'd like to see what she's doing professionally, checkout integrated diabetes.com That's where she works. If you're a US resident who has type one diabetes, or is the caregiver of someone with type one, please go to T one D exchange.org. Forward slash juicebox. Join the registry complete the survey support people living with type one diabetes T one D exchange.org. Forward slash juice box. At the end of this episode, I'll list all of the bold beginnings episodes that have come before it, just in case you have missed one.

This episode of The Juicebox Podcast is sponsored by in pen from Medtronic diabetes. And because this is a short episode, I'm going to give you the entire ad right now. lickety split real quick, you ready. The pen is an insulin pen that connects to an app on your cell phone. When that happens, it gives you much of the functionality that you would get with an insulin pump. It's also completely possible that the in pen may only cost you $35. Head to in pen today.com To find out more. When you get there. If you're ready to try it just fill out the form where it says ready to try and hit submit. But if you want to learn more, do some reading, find out about the pen, insulin cartridge holder dosing window a knob and injection button and a cap just like you would expect from an insulin bed. But then it connects to the app on your phone through Bluetooth, giving you your current glucose levels, meal history, dosing history activity log reports, glucose history, the act of insulin remaining and your dosing calculator. Also I also while you're on the page in Penn today.com You can learn more about the offer that is made to people with commercial insurance terms and conditions apply of course, but you may pay as little as $35 for your in pen. You know what else in Penn offers 24 hour Technical Support hands on product training and online educational resources. All of that is something you can learn about in more depth at in Penn today.com. In Penn requires a prescription and settings from your health care provider you must use proper settings and follow the instructions as directed where you could experience high or low glucose levels. For more safety information again, visit in Penn today.com. Today's episode is also sponsored by touched by type one, they'd love it if you'd find them on Facebook, Instagram, or it touched by type one.org. Jenny we have on our bold beginnings list. long acting insulin. It's a pretty short episode, I think based on the feedback but based on people's questions and statements about what they thought would have been helpful to know at diagnosis, we're going to include it here. Okay, so long acting insulin right away hits my brain wrong because I want to call it Basal insulin in my head, right? Same thing though long acting Basal we talked about a long time. Some examples are level mirror Lantis receba God give me more to jail,

Jennifer Smith, CDE 4:15
Basil Glar. I'm Yes. There's also if you want to include it in the same category in terms of considering long acting and basil as one thing, then we also have to include what was the old version of a Basal insulin, and that we now refer to it as more of an intermediate insulin, okay, it's an or NPH it's the kind that looks cloudy in the vial. And that has it has a shorter life. You have to dose it twice a day, but it's still considered long acting in terms of it covers that Basal insulin need, just not as long.

Scott Benner 4:58
I'm realizing as we're talking Get it this is going to be more than just about long acting insulin. So there are places in the country in the world where you may still be given mph when you're diagnosed. That's right. Okay. Absolutely. And that if people are given mph are they going to hear the word sliding scale every time?

Jennifer Smith, CDE 5:20
Many times, yes. Because of the way that that intermediate acting and or NPH works, it does. Today's Basal insulins or long acting are like a flat scape right there like a horizontal kind of, they go in, they start working and they have a flat impact once they're in a steady rate of action, whereas the intermediate acting insulins are dosed twice a day, because there is a bell curve or a peak in action, and then it floats back down, and then you take it again, and there's a peak in action, and then it floats back down. So sliding scale goes along with that, because oftentimes, if you're using n or NPH, you're also going to be using the more short acting kind of insulin called regular insulin. It takes a little longer for it to start working, but they're often dosed together, okay to to take care of two things, one mealtime coverage initially, and then the long acting insulin or that intermediate, and it's going to peak around the next meal time, or that's the goal of dosing it. So you may have short acting, and the intermediate together, the peak of the long or intermediate acting is going to be around a mealtime where you may not take extra insulin, because that peak is supposed to be covered by your next food intake. And thus, the term sort of sliding scale, take this much if your blood sugar is between this value and this value, this number of units of insulin, it's it's not precise. It requires you to get some information from the doctor prescribing that designates a specific amount of food to eat at each mealtime. Because those that sliding scale is specific to an amount of food that cover or an assumed amount of food to cover. And if you vary from that, you're going to have more erratic glucose control.

Scott Benner 7:40
Can I ask you why in 2022? Would people be given that insulin still

Jennifer Smith, CDE 7:45
depends where you are in the world? Okay. And we live in a very, I mean, we have a community here in the United States. That is, we complain about what we can get, but we can really get we shouldn't have complaints compared to third world countries and places that just really, I mean, they may not even have a glucometer to use in their own home. Right?

Scott Benner 8:10
Well, even beyond that, I still hear from people in some provinces in Canada, who are given mph when they're diagnosed and sliding scale and told shooted at this time of day, eat this many carbs at this time of day. And that's I mean, that really is management. Like you're saying based on modern management now, that's managed from the 80s.

Jennifer Smith, CDE 8:32
Yes, yeah, that was my management. Yeah. Hi, I did it.

Scott Benner 8:39
But it leaves you it leaves you open to a lot of, I think unknown sweat. Like I can't imagine doing like a regular and mph regimen and wearing a CGM. Because you probably see your blood sugar's get pretty high, stay high, come down low get low, like the whole thing.

Jennifer Smith, CDE 8:57
I believe that there will be a lot of frustration. Another reason that in again, a good number of the people that I get to work with are pregnant women, right. And there are still some OB practices that move towards the potential use of the n or the MPH at a specific time of day to cover a hormone impact that may not be being offset the right way, even if the woman is on a pump. Or we've navigated by adjusting doses and everything. Because the short action time of that n gives the allowance for peaking at the point of where you want more insulin really heavy hitting and sometimes it can be a beneficial added tool in that particular you know population

Scott Benner 9:51
but if I'm just a person diagnosed now modern times and somebody said here's it's regular an MPH and you're going to eat on a sliding scale, that's a red flag. To me, right? Yeah. We give like a lot of it's funny. I don't think of this as an advice driven podcast at all. Like, I never think to say like to somebody like don't. But if somebody says that to you, if you want my opinion, either tell the doctor, I want more modern insulins like the ones we're going to talk about in a second. And if the doctor doesn't know what you're talking about, you're looking for another doctor.

Jennifer Smith, CDE 10:20
Move on. Yeah, exactly. Yeah. Because especially if, and this again, is speaking to the terms of access, right? What people with good health care coverage and whatnot do have access to you should not be being put on an MPH and and regular insulin from the get go, you should have the option to do a much more flat acting insulin. And the oldest on the market is Lantus, at this point, followed pretty closely by love Amir, and then the newer ones are the two Jao and the truss EBA and the basic glower and you know,

Scott Benner 10:58
we're going to talk about them. Now, I just, I'm just going to add here, if for financial reasons, you're on regular and mph. I mean, Jenny's talking to you right now, many years later, after using it, it can be done. It's just not, it's not a preferred method at this point. So if you can get

Jennifer Smith, CDE 11:13
Yeah, and the biggest thing there is a little bit more scheduled to your day, can it be done? Absolutely. It can be done, and it can be done with success. If that's the case, then I you know, encourage trying to figure out a set structure to where you put your food in the day, because that's how your insulin is working.

Scott Benner 11:33
How much I don't mean to get off on a, like a personal conversation here too long. But how much of your, the cure Am I think of you as a person who eats without trouble? Like, I don't think of you as a person who eats healthy foods and is like the moaning at the whole time? Or does what they're supposed to do? And they're like, I really wish this was a flaming hot Cheeto. I wish I tried once, and I don't understand why you people like those. But that's okay. What I'm saying is this, how much of your regiment as a child, do you think impacts your eating style now? Has to write

Jennifer Smith, CDE 12:09
absolute? No, that's a, it's a great questions. question I've been asked a number of times, otherwise. I think it influenced a lot. And I think it influenced a lot because that was what my parents had to go by the I mean, the information was like, this is like the Bible to follow, right? You will feed your child and get her up at this time, and dose her insulin, she will have a snack here, it can be these types of foods. And it was figured out according I mean, you know, my my macro needs based on my growing body, it was figured out in that realm from a dietitian standpoint, as well as from a diabetes need standpoint. And I think a lot of that definitely moved me into kind of where I am today, as you I mean, as it is, I still get up. I am quite certain that the reason I'm an early riser, is because I had to take my insulin in the morning at a very specific time. Because my evening insulin was also a very specific time, and it had to be like 12 hours apart. And my parents were very strict about you know, so I don't get up early

Scott Benner 13:23
your health now is a is a testament to their taking that sliding scale seriously and really sticking to it. But it just occurred to me now it's like, oh, that's probably why your regimen you're regimented person because of that, you know? Okay, so

Jennifer Smith, CDE 13:40
it's also just my personality, and wherever it came from, I don't know. But yes,

Scott Benner 13:46
like your parents, obviously, were regimented to some degree too, because they were able to put it into I mean, listen, someone came along, like, Hey, your kids got all this stuff. And they're like, no problem. I'll have her up at 603. She'll be eaten at 645. It's gonna be 17 and a half carbs, you know, and we'll inject this and it's gonna, I interviewed a guy the other day, who grew up with a type one dad back in the was that was born in the diagnose the 50s. So it was a long, long time ago. And he said, one of the things he remembers and almost resents from childhood is that they had to eat at the exact same time dinner every night. So it didn't matter if he was playing. Everybody else would be like, Oh, come in later. It's like we had to eat because of my dad. Yeah, yeah.

Jennifer Smith, CDE 14:27
But I think it helps eventually. I mean, my dad was diagnosed with type two diabetes later, you know, in life. I was in college once he was diagnosed. And I think that sort of helped my mom move into that management with and for my dad, too.

Scott Benner 14:44
So she probably didn't have she was probably like, oh, this will be easy. Like I got this Hold on, let me get out my old books and Ledger's. But so Okay, so you're diagnosed. Hopefully you don't get mph and regular. Hopefully you get some sort of a Modern Basal or long acting insulin. Jenny just went over them lever Mir and Lantis are the older ones to Jao and TriCity Barsi. But the newer ones, depending on which one you get their action times are going to work differently. So the story I always tell is that Arden got that's funny now that I think about Arden got Lantis and it burned. So they, so they moved her to love Amir. And I remember being told that either Lantus or levemir definitely lasts for 24 hours, blah, blah, blah, this is how it works. You inject it once a day, and 24 hours later, you injected again, but we were seeing these highs on the level mere about 18 hours after she injected basil. And that's the first time somebody told me oh, you should try splitting your Basal insulin putting in some of it now and some of it 12 hours later to keep the coverage. more even. That was a big deal for us when she was MDI you know, splitting that love Amir, but now the more modern ones. You like I know you don't you're not in favor of splitting Lantis right. Personally,

Jennifer Smith, CDE 16:06
I'm not personally in favor of it. I've had probably definitely less than a handful of people that it did seem to work. Okay and and better for, but in general know, the Lantus, the two Jao, the, you know, trust Seba, all of those they are definitely supposed to be a 24 hour acting insulin right. Some people do find that Lantus doesn't quite get them to that 24 hour mark, that it sort of legs off, maybe somewhere after about 20 hours, and they have a little bit of potential need for more insulin, and that may be accomplished by just adjusting the dose of the rapid acting insulin if a meal falls within that time to make up for that little bit of deficit before you retake it. But the newer insulins definitely especially true Siva, Siva has a definite 24 hour and often in other in many people, it actually has a longer lingering effect.

Scott Benner 17:11
So I've anecdotally heard a few people who split Atlantis and say it works but you are very steadfast about saying that you don't so love Amir. Sure, you could split it if you don't think you were getting 24 hours. It worked for us, Lani, people need to split love Amir right. Lantis maybe not. Now those others? Definitely no. Yeah, they're just a no, don't split your Seba. Don't none of those they listen, you're saying they last 24 hours. I hear from people who say that it feels like it overlaps into the second day sometimes Correct, right?

Jennifer Smith, CDE 17:46
Yeah, in fact it in. I worked with a couple of like high school athletes, boys, who were MDI chose to be MDI for a number of reasons. And we worked it out, you know, to the point that we could navigate but what we ended up finding was that with the dose of True Seba, they actually needed a titration down in the dose by the end of a full week of athletic overlap, because there was so much overlap of the truck Seba and the activity factor that they were running in the toilet almost able to eat without bolusing for meals days by the end of the week, because because of the action.

Scott Benner 18:32
Oh, isn't that interesting? So So here's the thing. These are all injectable insolence. If your MDI are using an insolent, you know, or a pen or syringes, it doesn't matter which way multiple daily injections if you're using, you know, needles and not an insulin pump. So if you're using again, like with the mph, if somebody says, Hey, here's mph, say please don't please give me more modern insulin. And if someone says to you, hey, here's love America, please don't Can I have a more modern Basal insulin, please? Yes, you know, it's going to make things easier. Because Basal insulin, long acting insulin, whatever your doctor is going to call it is the background insulin that is working on. Basically its job as body functions, right body functions to try to push up your blood sugar, it's trying to keep you stable somewhere it's got it should have nothing to do with how you're impacting your food. In a perfect situation. You don't you know, you inject it once a day, it kind of think of it as time release, it kind of stays in your body and slowly gives off itself and works over these hours. It's, it's really, really important. And if you go back and listen to other episodes of this podcast, you dig into the Pro Tip series or any other stuff, you're going to hear me Jenny, anybody who's talking about say, Basil first, you have to get your basil right or other things are not going to work. And so you these First couple of leaps you have to get past are you giving me love Amir? Or are you giving me true SIBO? Are you and by the way, I don't know who makes there's there are different companies and etc. And you might have to work a little bit to find the insulin that works best for you. I don't care which one you use, I'm just saying you're gonna have different expectations, depending on which drug you have. Correct. If you don't have your basil correct, it's going to impact everything else, it's going to impact bolusing for meals, it's going to impact sleeping activity, it's going to mess with everything.

Jennifer Smith, CDE 20:34
Yeah, it's it's like building the foundation of your house out of straw instead of concrete.

Scott Benner 20:42
We did a nice stable base and is your long acting or Basal insulin. Now, some statements from people correcting overnight or splitting my Basal insulin was a huge help. So they were it sounds like they were correcting. They were probably shooting their basil in the morning. And by the late night, it wasn't working as much. So they were using corrections which now that's not long acting insulin that's fast acting insulin or meal insulin, but you may hear it called like Novolog a Piedra fiasco looms Avalon compute a few Milan for some reason, which is weird. And sudden this person realizes Oh, I don't have to correct your Bolus in the evenings if I just get my Basal insulin right. Yeah. Next person says, I wish I would have known the onset of action in the duration of action. From my long acting, considered splitting if appropriate, some long acting insulin so they're making our point for us. Since newly diagnosed will be MDI a nutshell summary of long and short acting insulin, perhaps with the end for emphasis on how Basal insulin impacts everything. So these this these are people who love the podcast are like if this is what I wish I knew now that I knew before. Okay, so let us dig into that for just a second here. A Nutshell summary. I think we've kind of done it long acting insulin Basal insulin. The ones we mentioned, short acting insulin meal insulin, again, the ones we mentioned, but what are they for? Basal insulin, again, is a base stability for your body function, you know, other stuff. Meal insulin is there to correct a high blood sugar or to combat food that you're eating. Correct. That's it, right? Yes, absolutely. One of the most frequently confused things the beginning of diagnosis is Basal and Bolus is Basal and

Jennifer Smith, CDE 22:39
Bolus. Yeah. And I think the words are, again, they're really clinical words, if we just broke it down to say, this is what this kind of insulin I'm prescribing is going to do for you. You must take it every day at about the same time, every single day, this is going to give you this background coverage that has nothing to do with food or anything else. You need it because your pancreas would be dripping this all day long. You know, and then the other explanation just being this one is going to work when you choose to eat food. If you don't eat, you don't take it unless you're high. And then here is your correction scale, blah, blah, blah.

Scott Benner 23:17
Yeah, it's just over the years, all the words have been co opted, you know, people explained the mountain and said Oh, correction insulin, that is a good way to think of it. I'll call it that. Instead of calling it Bolus insulin or mealtime insulin or and you'll The truth is, I don't know, Jenny, a couple of months into this. That's all going to make sense to you. Right? Like we're talking about it now. Like we're just like, you know how green is grass and blue is the sky everyone. When you're first diagnosed, you're like Basal Bolus long acting short acting. To Siva, who names that things

Jennifer Smith, CDE 23:52
when you want to take with you. In fact, for newly diagnosed I often recommend when you get those prescriptions home, make sure you read how to take them when to take them in the refrigerator, put a note on them a sticky note, something that specifically says this is your right away 6am In the morning long acting insulin. This is my take with food, correct blood sugar, insulin, and as long as you need to keep those sticky notes on there until it clicks in your head. Which one is for what? Keep them on there? I mean,

Scott Benner 24:25
once a month without fail. In the Facebook group. There is a long thread where someone says, Hey took the wrong entrance with the wrong insulin. What do I do and it always goes this way. It never goes the easy way. It never goes. I meant to take four units for a meal when I put it for extra units of basil. It's my basil 20 units and I just took it I just took 20 units of Novolog instead of 20 units of land. Yes. And what do I do? Beautiful watch people come in. They talk them through it real quickly do the math 20 units. So I know it sounds like a lot on how many carbs covers 20 units, it's snack time. You know, like, that kind of thing. And people I watched them get each other through it. It's really it's, it's, it's beautiful.

Jennifer Smith, CDE 25:11
At some point, I mean to delve down the rabbit hole a little bit, honestly at some point, there will hopefully be micro dose glucagon. That would help in an instance like that mistake that you know nobody intended to do, but that you wouldn't have to end up eating 200 grams of carb to offset what you did accidentally, right that, oh, I can do this much glucagon. And this will take care of this much of it and right

Scott Benner 25:41
without eating a pint of Ben and Jerry's ice cream or something like that. Yeah. Now, here's the thing, right, you're newly diagnosed, this all is probably what you're hearing because you're MDI, but long acting insulin, when you move to an insulin pump, if you move to an insulin pump will be replaced, you will not use with a pump, you will not use long acting insulin anymore. You'll use short acting meal insulin Bolus insulin in your pump, and your pump will replicate a Basal program for you, giving you tiny little bits constantly throughout the day to create. So instead of you kind of putting in that quote, unquote, time release Basal insulin and it being let go, you know, pharmaceutically, it's going to go into a pump and be electro mechanically

Jennifer Smith, CDE 26:26
Correct, right? Think of your pump like your pancreas. Honestly, yeah, your pancreas doesn't use two kinds of insulin. It uses the same type of insulin that those little beta cells pop out. And it does it for different reasons, right. So the pancreas or the pump is going to do the same thing. Use one kind of insulin, but in a different way. And here's where in vs. Big dose in,

Scott Benner 26:52
right. And here's where you start gaming. You know, if you asked me what the difference between pumping and MDI is, the first thing I think of is having agency over the Basal program and being able to change it. So earlier in this episode, Jenna use an example of young guys, athletes who are on MDI, who have a Basal an amount of Basal they're shooting Monday, Tuesday, Wednesday, Thursday, Friday, but because their activity is getting greater and greater as the week goes, the truth is that their Basal needs get lesser at the end of that active week. If you were on a pump, you could I'm just gonna make up numbers, you could be using one unit an hour on Mondays, one unit hour on Tuesdays, and Wednesdays point eight Thursdays point seven, right and to, to make adjustments based on what you know, that activity was going to do. Right? I'm not trying to tell you, you have to have a pump, I think any way you manage is is great if it works for you. But you do get more control over your Basal profiles once you're on a pump. And it is really amazing. And if you ever get past regular pumps into algorithm based pumps, you can really start seeing how manipulation of basil creates the

Jennifer Smith, CDE 28:05
precision comes in. Yeah, even Yeah, much clearer, because you

Scott Benner 28:09
go it's funny, we kind of made a timeline here. I want to say by mistake, but I was kind of thinking about it. So I'm gonna take a little bit of credit, but I'm back from the mph to the more modern Basal insulins to the idea of pumping to the idea of algorithms. Yep, just all those things are different levels of insulin being used in the correct amount at the correct time. Right.

Jennifer Smith, CDE 28:37
And it's an evolution definitely, I mean, what you're talking about is a is a movement forward from what was to what we have the opportunity to use now. And I think it's interesting having lived you know, 34 years with with diabetes, I have evolved through all of this now, I didn't start that with like boiling my needles and only peeing on a urine strip. Thankfully, I had some technology at my hands when I was diagnosed, but I feel like I've lived through a lot of the the true technology shift and change. And it's, it's amazing. It really is. So

Scott Benner 29:18
so I'm gonna I'm gonna recap, which I don't ever do. Someone gives the MPH go. Can I please have more modern insulin someone gives you Sorry? Pharmaceutical companies, although I don't not apologize, though, pharmaceutical company. They're doing okay. You know, if someone gives you 11 Mirror Lantis say, could I get something more modern than this? Once you've got that figured out. If there's more that you want, well, then you're probably interested in an insulin pump. And after you have an insulin pump, and you understand how that works, you might be interested in an algorithm. So this is an I don't know what comes after algorithm.

Jennifer Smith, CDE 29:53
I don't maybe a truly closed loop system that requires very little thinking other than Oh, it's the day that I have to put on my new pump and fill it up with insulin. Here you go.

Scott Benner 30:02
So in your mind, is that like a dual chamber with glucagon and insulin?

Jennifer Smith, CDE 30:08
That's what it would have to be, honestly, for it to truly work the best way possible. Yeah.

Scott Benner 30:15
Okay. All right. Well, if you're just diagnosed, don't bother thinking about that yet. I've been hearing people talking about that for 10 years, and I don't think we're anywhere near and so just

Jennifer Smith, CDE 30:25
the basic, learn the basics. Just be happy.

Scott Benner 30:29
Understand your insulin today and go about your. Alright. Thank you very much. Cool. Absolutely. All right. So we got that one out of the way. I just as I was reading, and I was like, There's way more to this than what the people asked

Jennifer Smith, CDE 30:40
what it's good to have brought in, I was hoping that you would bring in the fact of pumps, because we refer to Basal Bolus and a pump. But it's a change in mindset. I don't know how many people ask, even in today's world, when they're starting on a pump with you, they're like, well, when do I do I still keep taking my Basal insulin at the same time. I'm like, Yep, no, put it in the fridge, put a sticky note on it that says Do not touch

Scott Benner 31:05
Done with this now. Done. Yes. I mean, I told you the story recently, right of I don't mean to use her twice in the same series, but a woman who had had diabetes for like, 40 years. Yeah, I asked her about her Basal insulin, and she told me the wrong insulin. It's no, that's, that's something else. I mean, that's basic stuff there. We need, we need to understand that.

Jennifer Smith, CDE 31:27
Well, and that also speaks unfortunately, to whoever her practitioner is, has clearly not asked enough in terms of discussion, that's a back and forth discussion, to hear that this person was completely missing, or misunderstanding or whatever it was, I mean, that should have been addressed in the clinicians office.

Scott Benner 31:49
Yeah, you know, we're still recording Jenny, just because I didn't stop it. But and this is going to come up later in this series about picking medical help. But there there is definitely something to be said for that. Like, not everybody knows what the hell they're talking about. And it doesn't stop them from talking. You know, so you're you are newly diagnosed, you don't know what's happening, and you take everything as gospel out. You know, my my little story about insulin that I'll add at the end of this episode is that Arden uses a Peter to works really well for her. But we were given Novolog in the hospital, which is fine. But the point is, is that when someone handed me Novolog, and said here, this is insulin, I thought, well, this is insulin, there's this is it, there's no other insulin,

Jennifer Smith, CDE 32:37
insulin is just insulin, right? The word insulin indicates one thing.

Scott Benner 32:41
I even think it's ridiculous when we're rattling off, all the names are different than something how many of these do we need? Exactly. But you know, like, I just thought Novolog is insulin. It's for her Mealtimes are her corrections. And when NovaLogic didn't work, as well, for Arden as it did for other people, it never occurred to me that I could just say, can I try a different insulin, please? Yeah. And it? Because that's the I mean, to somebody's point earlier about having something drilled in your head in the 1515 episode. It was it just I believe them, like a person in a white coat, handed me over log and said, This is insulin, and my brain just said, Okay. You know, and then that stops you from asking questions. Yeah, yeah,

Jennifer Smith, CDE 33:22
absolutely. And I think I think there too, is the word insulin. And it really encompasses a lot. And there's a lot to understand about it, as we've just talked about. I mean, my understanding of insulin definitely shifted. Once I had done my own research when rapid insulin came on to the market. And I was reading more and learning more myself. And I went to my own doctor, and I said, Hey, I have to take my insulin, like 45 minutes before I can start to eat. This doesn't work with my life. There's this fancy new, more rapid acting insulin, can I please get a prescription for it? My doctor was like, Sure. Here's your new blog. Right. And before that I had been using our I mean, that dramatically changed. And my doctor knew about it, but I don't know that my doctor would have brought it

Scott Benner 34:22
up, right? No, because it's working. And why by the way, did you ask that question with a perm? Did you have a perm when you were saying that? I actually way up in the air. Well, I actually

Jennifer Smith, CDE 34:33
have naturally curly hair, so I've not ever had a perm. Is your hair straightened? It straightened right now? Yeah. I never think of it that way. But it's naturally curly. Otherwise,

Scott Benner 34:45
yeah. And to your to just tack on to that idea. The looms?

Jennifer Smith, CDE 34:50
They did have the big big bangs.

Scott Benner 34:52
You have big metal here. Did you have metal hair at any point?

Jennifer Smith, CDE 34:55
Oh, I guess maybe that I don't know that it was metal hair. I don't think my dad had would let me leave the house looking like that quite honestly. But I had the big bangs like the get it up there.

Scott Benner 35:07
A lot of girls I grew up with looks like that they put their finger in a socket and when their hair shot up in the air, they just sprayed it. They're good. All of us had molds at some point or another. But what was I gonna say? Oh, fie Aspen loon Jeff mealtime mealtime insulins that have a quicker onset? Yes, if they work for you. That makes Jenny's point right Jenny used to have to take regular and mph Wait 45 minutes to eat. Somebody gave her human log and suddenly you only had to wait what? 20 minutes to eat maybe? Right? Yep. And we'll talk about this in the Pre-Bolus episode that's coming up. But at the same time fiasco loom Jeff more modern fast acting insulins they hit even quicker. And you know, and who knows what comes next. I always think about when I was first getting into this interviewing people, I think I was talking to Aaron from the JDRF and he said we need faster acting insulins and better cannula material and I thought like huh, that's interesting, you know, like what he's seeing the other part like because your cannula from your pump to explain that idea looks like a foreign body to your to your body so kind of gets attacked by white blood cells. Eventually it could stop the insulin from working as well as you want to bring but not infection but just the inflammation to the air information which slows down the the absorption of the anyway, Aaron's like we need better cannula material and faster acting insulin. And those are two things you wouldn't think to pray for at night when you went to bed. But if you have diabetes,

Jennifer Smith, CDE 36:38
and smarter insulin I'm it's interesting from a JDRF perspective, it was years ago when I attended a JDRF. It was like a scientific presentation in the evening. And there was a gentleman from the East Coast, I think he was somewhere in the Boston area. A scientist who had done enough studies to get it to the animal based study of insulin that had almost an on off switch or a thermometer, if you will, that you injected it. I believe it was once a day. And that dose allowed your glucose level to stay within a determined target range turning on when it was climbing and going above that turning off when it was falling and coming down to the lower end of the target.

Scott Benner 37:26
Yeah. Which well make no mistake. That's the that's the golden chalice right there. Right? Yeah, yeah, I mean, and we can stop doing this podcast and I bad news for all the pump companies. You're out of business to

Jennifer Smith, CDE 37:39
be living on the beach in Tahiti? Well, probably not because that's pretty expensive.

Scott Benner 37:44
Chinese, like I'm taking whatever money I made telling people about diabetes, I'm going to the warmest place I can find I'm writing the rest of this thing out.

Jennifer Smith, CDE 37:52
So read books and

Scott Benner 37:55
does it I'm gonna let you go. But it feels like that. Right? Like, if somebody just took diabetes away, you'd be like, I've done enough for one lifetime. I'm good.

Jennifer Smith, CDE 38:03
Yeah, absolutely. I mean, I if there if there were there is a need in diabetes. I, I hope that I can continue to work and help. But if there is ever something that comes out, that's like, no, people don't have to think anymore. You still have to eat your food and drink your water and get exercise. But here it is. I'll be like, fantastic for everybody.

Scott Benner 38:25
Big Mike drops, and he's like I'm out of here. You get in the car or you're not coming because I'm leaving. Excellent. Alright, thank you so much.

A huge thanks to Ian pen from Medtronic diabetes for sponsoring this episode of The Juicebox Podcast in pen today.com To get started, where to learn more. Thanks also to Jenny Smith, who works at integrated diabetes.com If you're interested in procuring her services, that's where you would do it. I also want to thank you for listening for sharing the show and for being terrific. The other day, I received a photograph from the ninth listener who's bought a vanity plate for their car for the Juicebox Podcast. That is um, that's some cool listeners and some great dedication from you. Thank you so much

if you head over to the private Facebook page, which I'll do right now with you Juicebox Podcast type one diabetes. Get yourself in there scroll to the top click on Featured Isabel has all the lists set up for you Pro Tip series variables, etc. One of those lists is the bowl beginning series. I will read from it. Episode 698 defines the ball beginning series lets you know what we're planning on doing with it. Episode 702 is about honeymooning 706 adult diagnosis 711 terminology Part One 712 terminology part two, Episode 715 is fear of insulin and episode 719 is the 1515 rule. And of course in this episode we talked about long acting insulin. There's also a list there for defining diabetes that's 44 episodes of terms defined for you that you use every day with type one and type two diabetes very often. How about a nine episode series talking about celiac, and type one, or a 10 episode series about disordered eating 19 episodes dedicated to just me talking with kids, lots of interviews with me and the children 26 episodes Excuse me 27 episodes after dark series everything from drinking to disorder to eating psychedelics, living with bipolar people who have type one diabetes, and other extraordinary challenges often will be found in the after dark series. There's a 411 list called juicebox Asst. That has 16 Very popular episodes in no particular order. How about a 14 episode series about algorithm based pumps from loop to Omni pod five control IQ and there's way more coming in that series. Very soon. You can learn how to Bolus for fat and protein. And there are so many ask Scott and Jenny episodes where Jenny and I just answer listener questions. There is a growing list about mental wellness and type one many of the episodes are with licensed Marriage and Family Therapist Erica Forsyth, a type one herself. We have a small but but but strong list of type twos. I really would like more of you to reach out to be on the show always looking for type twos to be on the show. Please reach out if you're interested in coming on and building that series up for others. Defining thyroid is a 10 episode series that will help you understand thyroid disease. And our pregnancy list has just grown no pun intended to 12 episodes. There's a how we eat series where people come on to talk about their eating style carnivore plant based low carb Bernstein FODMAP keto flexitarian intermittent fasting vegan, that list is also on the move, looking for more people to come on and talk about how they eat. There's a quickstart guide episodes from episode four all the way up to episode 100. These are the episodes people say if you listen to you'll get a vibe for how I feel about type one, and it gets you into the podcast. And that's the Quickstart list. Don't miss the diabetes variable series 22 episodes, giving you looks into things that impact your blood sugar that you would never think of like hydration, sleep, weight gain, and more. And of course the diabetes Pro Tip series 25 episodes with Jenny and I are starting at episode 210 newly diagnosed you're starting over taking you through all the steps that I believe will help you bring your agency to where you want it to be. I hope you check them out. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.